End-tidal CO₂ Monitoring is Available in Most Community Hospitals in a Rural State: A Health System Survey.

Area of Science:

• Emergency Medicine
• Patient Safety
• Respiratory Monitoring

Background:

• Procedural sedation and analgesia (PSA) is crucial for managing pain and anxiety in emergency departments (EDs).
• Capnography use during PSA is a key safety measure, but its implementation varies.
• Understanding hospital-level factors influencing capnography use is essential for improving patient care.

Purpose of the Study:

• To identify hospital-level factors associated with the routine use of capnography during PSA in EDs.
• To investigate the relationship between hospital characteristics and capnography implementation for PSA.

Main Methods:

• A cross-sectional telephone survey of ED nurse managers in a Midwestern state was conducted.
• Data collected included hospital infrastructure, physician staffing (Family Practice vs. Emergency Physicians), and critical intervention capabilities.
• Hospital volume and rural-urban classification were obtained from external databases. Univariate analyses identified associations with PSA capnography use.

Main Results:

• 74% of EDs reported using capnography during PSA, while 97% used it for ventilated patients.
• Urban hospitals and those with higher patient volumes were more likely to use PSA capnography.
• Facilities staffed by board-certified Emergency Physicians were more likely to use PSA capnography compared to those with only Family Practice physicians.

Conclusions:

• Continuous capnography availability is widespread, but its use during PSA is less common.
• Smaller, rural EDs and those with limited resources face challenges in implementing capnography for PSA.
• Rurality and hospital size represent potential institutional barriers to adopting national guidelines for PSA capnography.